Purely cystic adrenal lesion in a newborn evolving into a solid neuroblastoma

Abstract

Purely cystic neuroblatomas are often discovered prenatally. As the main differential diagnosis is adrenal hemorrhage, follow-up sonography is warranted after birth. Cystic neuroblastomas are expected to evolve into lesions of mixed echogenicity with cystic and solid components. We present a rare case of a purely cystic left-sided adrenal lesion in a newborn, suggesting an adrenal hemorrhage, which on follow-up sonography evolved into a purely solid mass with poor vascularization, diagnosed as a cystic neuroblastoma. We suggest that even purely cystic adrenal masses in the newborn should be closely followed up with sonography, as they may represent purely cystic neuroblastomas.

Ultrasound follow-up of an unusual giant urinoma in a newborn

“…Differential diagnosis of perirenal and suprarenal masses covers a range of malignant and benign lesions: neuroblastoma, lymphangioma, extralobar pulmonary sequestration, congenital adrenal hyperplasia, partial multicystic dysplastic kidney, renal duplication, urinoma, gastric duplication cyst, splenic cyst, and bronchogenic cyst [9][10][11][12]. In case of cystic lesions near the kidney, the adrenal region should be carefully investigated.…”

“…In fact, among neuroblastomas the complex cystic appearance is the most common, comprising 50% of cases. Furthermore, perinatal cystic neuroblastoma and adrenal hemorrhage may have a similar initial US presentation, and only the evolution of a cystic lesion into a purely solid mass accompanied by calcification and flow on color Doppler suggests the diagnosis of neuroblastoma [11]. Renal lymphangioma, a rare disorder that likely results from the developmental malformation of the lymphatic communicating vessels, typically manifests itself as unilocular or multilocular cystic structures with fine or gross septations [12].…”

Cystic adrenal lesions: focus on pediatric population (a review)

“…During the neonatal period the most important differential diagnosis of adrenal hemorrhage is cystic neuroblastoma which is highly suggestive in the presence of distant metastases and abnormal catecholamine profile [ 92 ]. The major clue to differentiate the two conditions is the fact that the cystic tumor is stable or increases over time while the adrenal hemorrhage is expected to remit within one to two weeks [ 93 ]. The hemorrhagic structure remission has different stages: acute (while the adrenal cystic mass has variable echogenicity), sub-acute with hypoechoic ultrasound pattern due to liquefaction and later on a hyperechoic structure due to clot retraction and potential calcification is registered [ 94 ].…”